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Background: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities.
Methods: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups.
Results: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data.
Conclusion: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.
Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey
Cattalini M
Membro del Collaboration Group
;Della Paolera S
Methodology
;Zunica F
Membro del Collaboration Group
;Bracaglia C
Methodology
;Giangreco M;Verdoni L
Conceptualization
;Meini A
Project Administration
;Sottile R
Project Administration
;Caorsi R
Writing – Original Draft Preparation
;Zuccotti G
Project Administration
;Fabi M
Membro del Collaboration Group
;Montin D
Conceptualization
;Meneghel A
Formal Analysis
;Consolaro A
Membro del Collaboration Group
;Dellepiane RM
Software
;Maggio MC
Investigation
;La Torre F
Conceptualization
;Marchesi A
Conceptualization
;Simonini G
Data Curation
;Villani A
Membro del Collaboration Group
;Cimaz R
Membro del Collaboration Group
;Ravelli A
Membro del Collaboration Group
;Taddio A Maria Concetta Alberelli: UOC Pediatria;Marche-Nord;Clotilde Alizzi: Department of Health Promotion Sciences Maternal and Infantile Care;Internal Medicine and Medical Specialities “G. D’Alessandro”;University of Palermo;Palermo Italy;Patrizia Barone: Unità Operativa Complessa di Broncopneumologia Pediatrica AOU “Policlinico - Vittorio Emanuele Via Santa Sofia 78 Catania;Lucia Augusta Baselli: Pediatric Intermediate Care Unit;Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico;Milan Italy;Veronica Bennato: U. O. Pediatria;Ospedale A;Manzoni Lecco;Francesca Biscaro: UOC Pediatria;Ospedale Ca’ Foncello;Treviso;Grazia Bossi: UOC Pediatria;Fondazione IRCCS Policlinico San Matteo;Pavia Italy;Andrea Campana: Bambino Gesù Children’s Hospital;Rome Italy;Maurizio Carone: UO Malattie Infettive;Ospedale Pediatrico ‘Giovanni XXIII’;Bari Italy;Adele Civino: U. O. C. Pediatria P. O. Vito Fazzi, Lecce;Giovanni Conti: Nefrologia e Reumatologia Pediatrica con Dialisi, Azienda Ospedaliero-Universitario “G. Martino”;Eleonora Dei Rossi: University of Trieste;Trieste Italy;Emanuela Del Giudice: Department of Maternal Infantile and Urological Sciences;Sapeinza University of Rome;Polo Pontini;Rome Italy;Alice Dell’Anna: U. O. C. Pediatria P. O. Vito Fazzi Lecce;Maia De Luca: Bambino Gesù Children’s Hospital;Rome Italy;Piazza S. Onofrio n. 4;00165 Rome;Italy;Enrico Felici: Pediatric and Pediatric Emergency Unit;The Children Hospital;AO SS Antonio e Biago e C. Arrigo;Alessandria Italy;Giovanni Filocamo: Fondazione IRCCS Cà Granda;Ospedale Maggiore Policlinico;Milano;Ilenia Floretta: Pediatria;Ospedale Santa Chiara;Trento Italy;Maria Loreta Foschini: SC Pediatria;PO SAN MICHELE AOBrotzu;Cagliari Italy;Marcello Lanari: Department of Pediatrics;University of Bologna;IRCCS S. Orsola-Malpighi Hospital;Bologna Italy;Bianca Lattanzi: SOD Pediatria;Ospedali Riuniti;Ancona Italy;Alessandra Lazzerotti: Clinica Pediatrica;Università Milano Bicocca;Fondazione MBBM - onlus c/o Ospedale San Gerardo;Monza Italy;Francesco Licciardi: Department of Pediatrics and Public Health;University of Turin;Turin Italy;Alessandra Manerba: Child Cardiology;ASST Spedali Civili di Brescia and University of Brescia;Brescia Italy;Savina Mannarino: Division of Cardiology;Children’s Hospital V Buzzi;ASST FBF Sacco;Milan Italy;Achille Marino: Department of Pediatrics;Desio Hospital;ASST Monza;Desio Italy;Agostina Marolda: Pediatrics and Neonatology Dipartment;ASST Ovest Milanese;“G. Fornaroli” Hospital;Magenta Milan;Laura Martelli: Paediatric Department;Hospital Papa Giovanni XXIII;Bergamo Italy;Giorgia Martini;Department of Woman’s and Child’s Health;University of Padova;Padua Italy;Angela Mauro: Department of Paediatrics;Emergency Department;Santobono-Pausilipon Children’s Hospital;Naples;Italy. Maria Vincenza Mastrolia: Pediatric Rheumatology Unit;AOU Meyer;University of Florence;Florence;Italy. Angelo Mazza: Paediatric Department;Hospital Papa Giovanni XXIII;Bergamo Italy;Angela Miniaci: Clinica Pediatrica;Reumatologia;Azienda Ospedaliero-Universitaria di Bologna;IRCCS S. Orsola-Malpighi Hospital;Bologna Italy;Francesca Minoia: Fondazione IRCCS Cà Granda;Ospedale Maggiore Policlinico;Milano;Alma Olivieri: Dipartimento della donna;del bambino e di chirurgia generale e specialistica;Università della Campania;“L Vanvitelli;Napoli;Guido Pennoni: Dipartimento Materno-Infantile;Gubbio-Gualdo Tadino, Italy;Rossana Pignataro: UOC Pediatria e Neonatologia;ASST Lodi;Lodi;Francesca Ricci;Clinica Pediatrica;ASST Spedali Civili di Brescia e Università degli Studi di Brescia;Brescia Italy;Donato Rigante: Department of Pediatrics;Univarsità Cattolica Sacro Cuore;Rome Italy;Matilde Rossi: UOC di Pediatrai e Neonatologia;Ospedale di Macerata;Macerata;Claudia Santagati: Dipartimento di Pediatria;Ospedale di Rovigo;Rovigo;Martina Soliani: Pediatria ASST Cremona, Italy;Silvia Sonego: University of Trieste;Trieste Italy;Domenico Sperlì: UOC di Pediatria, S. O. “Annunziata” - A. O. di Cosenza;Sara Stucchi: Maternal and Child Health;Division of Paediatrics;ASST Grande Ospedale Metropolitano Niguarda;Milano Italy;Barbara Teruzzi: Maternal and Child Health;Division of Paediatrics;ASST Grande Ospedale Metropolitano Niguarda;Milano Italy;Elpidio Tierno: UOC di Pediatria;Dipartimento della Salute della Donna e del Bambin;AORN “Sant’Anna e San Sebastiano”- Caserta;Tatiana Utytatnikova: Dipartimento Materno-Infantile;Pediatria;ASST Bergamo-EST;Seriate Bergamo;Piero Valentini;Department of Pediatrics;Univarsità Cattolica Sacro Cuore;Rome Italy;Gianluca Vergine;UOC Pediatria Rimini;Ospedale Infermi;ASL Romagna;Rimini Italy.
2021
Abstract
Background: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities.
Methods: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups.
Results: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data.
Conclusion: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11591/449901
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Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
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